在标准化诊断工具中，针对ASD的DSM-5诊断标准有多好？,European Child & Adolescent Psychiatry

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在标准化诊断工具中，针对ASD的DSM-5诊断标准有多好？
European Child & Adolescent Psychiatry ( IF 6.0 ) Pub Date : 2020-02-19 , DOI: 10.1007/s00787-020-01481-z
Kris Evers _{1,

2,

3} , Jarymke Maljaars _{1,

2,

3} , Sarah J Carrington ₄ , Alice S Carter ₅ , Francesca Happé ₆ , Jean Steyaert _{2,

3,

7} , Susan R Leekam ₈ , Ilse Noens _{1,

2}

Affiliation

DSM-5于2013年发布五年后，三种广泛使用的诊断工具已经发布了算法，旨在代表其针对儿童和青少年的自闭症谱系障碍（ASD）标准。这项研究旨在：（1）建立这三种DSM-5自适应算法的内容有效性，以及（2）在可测量和可观察到的行为中确定DSM-5诊断标准的可操作性问题。自闭症诊断观察时间表第二版（ADOS-2），发展，维度和诊断访谈（3di）和社交和沟通障碍诊断访谈第11版（DISCO-11）的算法项已映射到DSM-5子目录中标准。然后将他们算法中集成的开发和决策规则与DSM-5进行了比较。结果表明，ADOS-2、3di和DISCO-11涵盖的子标准的数量和性质存在很大差异。除了算法开发和分界分数的差异外，仪器在遵循DSM-5决策规则进行诊断分类的程度上也有所不同。我们得出结论，DSM-5标准解释中的此类差异为症状操作化提出了挑战，而共识，测试和重新制定将最有效地克服这一问题。

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How well are DSM-5 diagnostic criteria for ASD represented in standardized diagnostic instruments?

Five years after the publication of DSM-5 in 2013, three widely used diagnostic instruments have published algorithms designed to represent its (sub-)criteria for Autism Spectrum Disorder (ASD) in children and adolescents. This study aimed to: (1) establish the content validity of these three DSM-5-adapted algorithms, and (2) identify problems with the operationalization of DSM-5 diagnostic criteria in measurable and observable behaviors. Algorithm items of the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2), Developmental, Dimensional and Diagnostic Interview (3di) and Diagnostic Interview for Social and Communication Disorders-11th edition (DISCO-11) were mapped onto DSM-5 sub-criteria. The development and decision-making rules integrated in their algorithms were then compared with DSM-5. Results demonstrated significant variability in the number and nature of sub-criteria covered by the ADOS-2, 3di and DISCO-11. In addition to differences in the development of algorithms and cut-off scores, instruments also differed in the extent to which they follow DSM-5 decision-making rules for diagnostic classification. We conclude that such differences in interpretation of DSM-5 criteria provide a challenge for symptom operationalization which will be most effectively overcome by consensus, testing and reformulation.

更新日期：2020-02-19

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